Among some of the first patients hospitalized with Covid-19, about half still had at least one persistent symptom associated with the illness a year later, researchers report.
The follow-up cohort study, published online Aug. 26 in The Lancet, included Covid-19 survivors discharged from a single hospital in Wuhan, China, from early January to late May 2020.
Fatigue, muscle weakness, and shortness of breath were among the most commonly reported long-haul symptoms. While most symptoms associated with Covid-19 had resolved in the former patients within a year of hospital discharge, 49% continued to report at least one long-haul symptom related to the illness.
One year later the Covid-19 survivors who had required hospitalization were found to have lower health status than matched community controls who did not become ill with Covid-19.
“Our study is the largest to date to assess the health outcomes of hospitalized Covid-19 survivors after 12 months of becoming ill,” researcher Bin Cao of China-Japan Friendship Hospital, Beijing, noted in a written press statement.
“While most had made a good recovery, health problems persisted in some patients, especially those who had been critically ill during their hospital stay. Our findings suggest that recovery for some patients will take longer than one year, and this should be taken into account when planning delivery of healthcare services post-pandemic,” Cao said.
Their ambidirectional cohort study included Covid-19 survivors discharged from Wuhan’s Jin Yin-tan Hospital between Jan. 7 and May 29, 2020.
At 6-month and 12-month follow-up visits, the survivors completed questionnaires exploring symptoms and health-related quality of life (HRQoL), and they also underwent a physical examination, a 6-min walking test, and laboratory testing. Health-care use after discharge and work status were also recorded at the 12-month visit, and study participants who had completed pulmonary function tests or had lung radiographic abnormality at 6 months were given the corresponding tests at 12 months.
Non-Covid-19 participants (controls) matched for age, sex, and comorbidities were interviewed and completed questionnaires to assess prevalent symptoms and HRQoL. The primary outcomes were symptoms, modified British Medical Research Council (mMRC) score, HRQoL, and distance walked in 6 min (6MWD).
Multivariable adjusted logistic regression models were used to evaluate 12-month outcome risk factors.
A total of 1,276 Covid-19 survivors completed both the 6- and 12-month visits (median patient age, 59 years (IQR 49–67) and 681 [53%] were male).
Among the main findings:
- The proportion of patients with at least one sequelae symptom decreased from 68% (831/1,227) at 6 months to 49% (620/1,272) at 12 months (P<0.0001).
- The proportion of patients with dyspnea, characterized by mMRC score of 1 or more, slightly increased from 26% (313/1,185) at 6-month visit to 30% (380/1,271) at 12-month visit (P=0.014).
- More patients had anxiety or depression at the 12-month visit (26% [331/1271] versus 23% [274/1187] at 6-month visit; P=0.015).
- No significant difference on 6MWD was observed between 6 months and 12 months.
Difficulty sleeping, heart palpitations, joint pain, chest pain and shortness of breath were commonly reported 1 year after hospital discharge. Yet most patients (88%) who were employed before being hospitalized with Covid-19 had returned to their original work at 12 months.
Compared with men, women had an odds ratio of 1.43 (95% CI, 1.04-1.96) for fatigue or muscle weakness, 2.00 (95% CI, 1.48-2.69) for anxiety or depression, and 2.97 (95% CI, 1.50-5.88) for diffusion impairment.
Compared to controls, matched Covid-19 survivors at 12 months had more problems with mobility, pain or discomfort, and anxiety or depression, and had more prevalent symptoms.
Study limitations cited by the researchers included a moderate response rate among former patients invited to join the study, along with the single-center study design. The fact that the cohort was confined to people hospitalized with Covid-19 also prevented generalization of the findings to those who did not require hospitalization.
The researchers concluded that ongoing longitudinal follow-up is needed to “better characterize the natural history and pathogenesis of long-term health consequences of Covid-19.”
In an accompanying editorial, Lancet editors wrote that long-Covid remains a poorly understood public health concern, and they called on the research community to address the many unanswered questions surrounding it.
“A cohesive research agenda is needed to prevent research waste and improve outcomes for patients,” they wrote. “The scientific and medical communities must collaborate to explore the mechanism and pathogenesis of long-Covid, estimate the global and regional disease burdens, better delineate who is most at risk, understand how vaccines might affect the condition, and find effective treatments via randomized controlled trials,” they wrote.
They added that health-care providers must also “acknowledge and validate the toll of the persistent symptoms of long-Covid on patients and health systems need to be prepared to meet individualized, patient-oriented goals with an appropriately trained workforce involving physical, cognitive, social and occupational elements.”
Among some of the first patients hospitalized with Covid-19, about half still had at least one persistent symptoms associated with the illness a year later.
Fatigue, muscle weakness, and shortness of breath were among the most commonly reported long-haul symptoms.
Salynn Boyles, Contributing Writer, BreakingMED™
This research was funded by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, Natural Science Foundation of China; the National Key Research and Development Program of China; and others. The researchers declared no relevant conflicts of interest related to this study.
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